Monthly Archives: July 2017

Nothing Really Changes: David Bowie was Right…..

Kevin R. Campbell, MD, FACC

CEO, K-Roc HealthCare Consulting, LLC

In one of his famous songs, “Changes”, David Bowie wrote: “where’s your shame, you’ve left us up to our necks in it” This lyric seems just as appropriate today as it did when he first published the lyric in 1971. Our leaders in Washington have done little this year other than bicker, obstruct the legislative process and stir controversy via twitter. All this is happening as the world is becoming an even more dangerous place—North Korea has ICBM capabilities, Syria continues to murder its own people and millions of Americans are suffering without adequate healthcare. Both parties are to blame. When I study history, there are always inspiring leaders that become the icons of their time—today there are NO heroes in DC.

The last week has been particularly disappointing. After 8 years of criticizing Obamacare and even putting legislation on Obama’s desk to repeal the ACA (which was promptly vetoed), a now Republican controlled Congress has not fulfilled its most central promise—reform healthcare. In addition, President Trump, who promised to protect the LBGTQ community when on the campaign trail, has now unilaterally banned transgender Americans from serving in the military. Infighting and leaks within Trump’s White House staff have created even larger distractions—and unparalleled provided fodder for light night television. All the while, our nation’s problems continue to grow without ANY real solutions on the horizon.

Just when I thought Washington could not get any worse, our elected officials have found a way to sink even lower.

As a lifelong conservative and registered Republican, I made a difficult decision this past week. I revised my party affiliation.

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(Photo courtesy of Dr Kevin Campbell)

My disgust crosses party lines—Democrats such as Hilary Clinton, Nancy Pelosi and Chuck Schumer represent all that is wrong with politics. Self-serving, out of touch long time politicians who care more about their own personal gain than those who the supposedly represent. The Republicans—who promised immediate action if they were given the power to pass legislation—have provided the American people with the biggest “bait and switch” in history. Rather than focus on moving on important legislative matters, both Republican controlled houses of Congress have simply stalled any progress due to intra party disagreements.

Ultimately, those in Washington need to be held accountable for their inaction. No longer should we, as voters, focus on a two party system and work towards protecting a majority or voting along party lines. I believe that each of us must carefully evaluate the job our leaders are doing and clearly call them out on any missteps. When Senators and Congressmen and women are up for re-election in our districts—and it is clear that they have not worked to move our country forward—we MUST vote them out. WE, as AMERICANS, can impose our own term limits. No longer do we have to tolerate the same disgusting politicians every single year. WE have the ability to invoke CHANGE—and, as David Bowie writes, “Time may change me, but I can’t trace time…” Simply put, we don’t have to retrace the past in Washington year after year—vote for change.

 

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(Screenshot via Wikipedia)

Wake UP Congress: America is WAITING for Healthcare Certainty

Kevin R. Campbell, MD, FACC

Cardiologist and CEO, K-Roc Consulting LLC

In the last week, the Senate has failed to produce a viable bill to reform healthcare in the US. BOTH parties are to blame. The Democrats, led by Chuck Schumer have made it clear that they are focused on obstruction of ANY legislation. The Republicans, who own a majority in both houses, cannot seem to come to any consensus—infighting has crippled Republican leadership and severely limited their ability to pass any significant legislation. Sound bites are dominating the news with each side of the aisle pointing fingers at the other. Political posturing is consuming the time of our Congress and very little cooperation and progress is apparent. Democrats accuse the Republican majority of secrecy and a lack of transparency during the development of the healthcare bill—the exact same behavior exhibited by the Democratic majority during the creation of Obamacare more than eight years ago. All of the men and women in Congress were elected to do a job—unfortunately, most are spending more time championing individual causes and playing to cameras than they are actually working to negotiate solutions to legislative problems. As we celebrate the 4th of July holiday this week, I expect better from those who are elected to represent the people of this great country.

 

The Current Issues:

  1. Obamacare is no longer viable. While the ACA legislation does insure large numbers of Americans on paper, the reality is that many of the newly insured have been left with minimal access, high costs (that continue to rise) and very limited choice. If Congress chooses to do nothing, it is likely that more insurers will abandon the exchanges and leave even more Americans will be left without any insurance choices—AND, under current law, be fined for not having insurance (even though there may be nowhere to purchase a plan). Moreover, the uncertainty in the insurance market has resulted not only in a mass exodus of insurers but has also driven up premiums to levels that prohibit many from affording anything more than “catastrophic” type plans with high deductibles and minimal coverage. There is no focus on preventative care and many Americans continue to go without any care at all.

 

  1. The current Republican proposal in the Senate does some—but not nearly enough– to fix the problems with the ACA. While the Senate bill does eliminate the individual mandate and many of the taxes associated with Obamacare, it does not address many of the core issues that both doctors and patients consider vital to any meaningful reform. For instance, there is nothing that addresses the rising prices of pharmaceuticals (and price gouging by pharma CEOs). Americans pay more than any other country in the world for drugs—Why can’t Medicare negotiate prices with pharma? In addition, there is no provision to allow for the purchase of drugs from foreign pharmacies such as those in Canada. Allowing foreign competition will certainly lead to lower prices within the US. Additionally, the plan does little to limit insurance costs—we were promised legislation that would provide for free competition among insurance companies across state lines—in order to allow free market forces to lower prices and improve services. This has not occurred and is not part of any Republican proposal in the Senate. Most significantly, there is no attempt to address tort reform in order to lower healthcare costs. Doctors continue to drive costs by ordering unnecessary tests in order to avoid frivolous litigation by trial lawyers.

 

My “4th of July” Take

It is clear that neither Democrats nor Republicans are ready to come to the table to work together towards meaningful reform. The President has offered little leadership of substance in the healthcare debate other than making vague statements such as “we are going to get this [healthcare] deal done and its going to be great”. Both sides are to blame for the rising cost of insurance and the runaway prices of pharmaceuticals. While the Democrats are unified on a plan of ‘legislative resistance’, Republicans continue to bicker about whether or not the healthcare bill is ‘too moderate’ or too conservative’. At this point, I do not believe the Republican proposal goes far enough to fix the pending healthcare crisis in our country today. Ultimately, doctors want to be able to take care of patients without government interference and patients want the freedom to choose their healthcare and purchase an affordable insurance plan that best meets their individual needs. We must get Congress to act—we need transparency in healthcare pricing and we need to hold both pharma and insurers accountable. We must also hold lawmakers accountable in November—either get the job done, or get out. America can no longer tolerate the status quo in Washington. The 4th of July symbolizes our right as Americans to determine our own destiny. Remember, the election of 2016 was all about disruption and a rejection of business as usual—Wake Up Congress, you have been put on notice. Fix healthcare or the voters will once again speak loudly during the next election cycle.

 

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The VA System Should Address the Physician Shortage By Hiring More Physicians, NOT by replacing them with NPs.

Kevin R. Campbell, MD, FACC

Cardiologist and CEO, K-Roc Consulting LLC

Contributor, Washington Examiner

 

In January of this year, the Veteran’s Administration (VA) made the decision to allow Nurse Practitioners (NP) to practice without any physician supervision. While NPs have a vital role to play within the healthcare system, they are NOT doctors and they are not qualified to replace physicians—even in a primary care environment. Those in leadership within the VA system argue that the physician shortage has left them with no choice but to allow NPs to practice unsupervised. However, I believe that we should be addressing the physician shortage by actually recruiting more physicians to care for primary care in the VA system. Our veterans deserve the very best care—and while NPs are caring, competent members of the healthcare team, they do not have the same training as physicians and are not equipped to fill the role of an independent physician. According to current VA statistics, there are roughly 93,500 nurses employed by the VA—of these 5,700 of them are advanced practice, meaning they have a master’s or doctoral degree in a nursing specialty. In the past, individual states are able to determine whether or not NPs are able to practice independently and 22 states already allow unsupervised practice.

How are NPs and Physicians Different?

Nurse practitioners and physicians are trained in very different ways. Physicians first must obtain a four-year undergraduate degree and then attend a four year medical school. Following medical school, physicians must complete an Internship and Residency with more than 21,000 hours of a standardized educational and training process. The minimum residency program is three years, and some specialties require almost 10 years of post-graduate training—all before ANY independent and unsupervised practice is allowed. By contrast, advanced practice nurses obtain around range from 3,500 to 6,600 hours of coursework and formal training—including Master’s or Doctoral degrees.

Physicians complete endless years of “in house” training in hospitals (taking overnight call as frequently as every third night). During these overnight shifts, physicians learn—while being supervised by an endless hierarchy of medical professionals—how to diagnose and manage very complex diseases. Nurse practitioners do perform time training in a clinical setting but they do not have the same responsibilities nor autonomy. Residency and other practical on the job training teaches young doctors judgment and improves clinical acumen—and this takes years of practice. Nurse practitioners simply do not have the same opportunity to gain these insights.

Before The Angry Response Begins—Everyone Has an Important Role to Play on the Healthcare Team

When I write articles such as this, I am often met with harsh criticism from professional organizations that represent advance practice nurses. Let me say at the outset that this is not a turf war—it is about making sure that every patient has access to BOTH a competent caring and well trained physician as well as an exceptional advance practice nurse. Rather I am arguing that we should continue to develop the idea of a TEAM approach to healthcare. Advance practice nurses are very good at developing meaningful relationships with patients and they are very good at treating common ailments and disease. Patients enjoy the time that NPs are able to devote to them in the office or hospital. Physicians are often rushed from patient to patient and procedure-to-procedure and do not have the same luxury of time to spend with the patients who need us. Physicians are exceptional at recognizing clues and symptoms and DIAGNOSING disease. Advance practice nurses, while exceptional in their role as caregivers and in the treatment of common primary care ailments, they simply do not have the experience needed to make complex diagnoses. While many NPs will argue that there are data from 2014 to show similar outcomes in patients managed by NPs versus physicians, the devil is in the details. The studies did not report whether or not the NPs were consulting with physicians in the management of their patients or whether they were practicing alone. In addition, none of these studies actually looked at DIAGNOSITC accuracy. Making the correct diagnosis and choosing the most appropriate treatment is the most important job of primary care physicians. As diseases do not always present as they do in a textbook, this is where experience and extensive training can make all the difference in the life of a patient. Physicians are used to working in packs—different doctors have different specialties and areas of expertise—we refer to others when we are outside of our specialties. Nurse Practitioners are asked to work with a wide variety of patients and often, in my experience, they do not know when to refer for a higher level of care or for more advanced treatments by a specialist physician—these instincts come from years of experience—like the experience gained during post graduate residency training.

The Bottom Line—Don’t Replace Physicians, Augment the TEAM

The VA and other states that are allowing independent NP practice are looking for a quick fix for the doctor shortage. However, those in charge are not putting the best interests of patients first—they are simply “filling coverage holes”. Rather than allowing NPs to practice outside of their scope of training (ie without MD supervision) we should be working to figure out why doctors are leaving the healthcare industry. We need to examine quality of life and burnout and we need to begin to listen to the needs of our healthcare providers. We must recruit more young dedicated primary care doctors AND, at the same time, expand the role and significance of NPs on the healthcare team. Until we do this, doctor shortages will continue to mount. Inadequacies in the VA system such as long wait times, fraud and abuse are more about the VA leadership and administration than they are about physician shortages.

 

We must also work to promote more understanding between physicians and advanced practice nurses. We must all work with a single goal in mind—providing patients with outstanding care and improved health outcomes.

So, for now, I must strongly object to the decision made by the VA system. Patients definitely need nurses—and advance practice nurses—BUT they also deserve access to a licensed, board certified, residency trained Doctor as well.

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(image via screenshot of VA.gov website)